In 2016, the majority of reported patients with gonorrhea (81%) received the recommended regimen regardless of age or race/ethnicity. However, patients diagnosed with gonorrhea in sexually transmitted disease (91%) or family planning/reproductive health (94%) clinics were more likely to receive this regimen than patients diagnosed in other provider settings (80%), according to a recently published report in the Morbidity and Mortality Weekly Report.
To monitor adherence to the current recommended regimen, the Centers for Disease Control and Prevention (CDC) reviewed enhanced data collected in a random sample of reported cases of gonorrhea in 7 jurisdictions. A total of 91,719 cases were reported in the 7 participating jurisdictions in 2016: Baltimore, Maryland; California, excluding San Francisco; Florida; Massachusetts; Multnomah County, Oregon; Minnesota; and Philadelphia, Pennsylvania.
Overall, 93.3% of these patients had a documented treatment and were included in the analysis. Based on the provider report of treatment provided, patients with the recommended dual therapy for uncomplicated gonorrhea were classified as having received the recommended regimen while all other patients were classified as having received other regimens. Gay, bisexual, and other men who have sex with men (MSM) were defined as any male patients who reported their sexual orientation as gay or bisexual or reported male sex partners in the previous 2 to 3 months.
The CDC estimated that 81.3% of reported patients with gonorrhea in these jurisdictions were treated with the recommended regimen (ceftriaxone 250 mg plus azithromycin 1 g) and the percentage of patients treated with the regimen varied by jurisdiction. Although not statistically significant, women were less likely to receive the recommended regimen than men (79.3% vs 82.5%; prevalence ratio [PR] = 0.96). Furthermore, heterosexual men and women were less likely to receive the recommended regimen compared with MSM (79.4% vs 84.8%; PR = 1.07).
In addition, patients diagnosed with gonorrhea in family planning/reproductive health clinics were more likely to receive the recommended regimen than patients diagnosed in other provider settings (93.8% vs 79.5%; PR= 1.18). In a similar fashion, patients diagnosed in sexually transmitted disease clinics were also more likely to receive the recommended regimen than patients diagnosed in other provider settings (90.8% vs 79.8%; PR= 1.14). Overall, 18.7% of patients received other regimens, with the most frequent regimens being ceftriaxone 250 mg only (5.9%), ceftriaxone any dosage plus doxycycline (4.4%), and azithromycin only (3.1%).
Although the 7 jurisdictions examined represent only approximately 20% of all gonorrhea cases in the United States as of 2016, the study investigators concluded that to help assure that patients receive the highest quality of care and to address the emerging threat of antimicrobial-resistant gonorrhea, “monitoring treatment practices across all provider and diagnostic settings helps identify opportunities for interventions to increase provider adherence.”
Weston EJ, Workowski K, Torrone E, Weinstock H, Stenger MR. Adherence to CDC recommendations for the treatment of uncomplicated gonorrhea – STD surveillance network, United States, 2016. MMWR Morb Mortal Wkly Rep. 2018;67(16):473-476.